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Abstract

Background: This paper describes the process used to develop an integrated set of culturally sensitive,
evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention
was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro
Region of Tanzania.

Methods: Formative research using a combination of qualitative methods preceded the development of the
intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF)
among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the
development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/
IF guidelines and formative research findings contributed to the definition of performance and learning objectives.
Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV
were then developed and/or adapted from existing generic materials. Draft materials were field tested with
intended audiences and subjected to stakeholder technical review.

Results: An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included
brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer
Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for
demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images
based on local ideas and resources. The brochures are meant to serve as both a reference material during infant
feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and
as take home material for the mother.

Conclusion: The study underscores the importance of formative research and a systematic theory based
approach to developing an intervention aimed at improving counselling and changing customary feeding practices.
The identification of perceived barriers and facilitators for change contributed to developing the key counselling
messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their
significant others.